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General NPI Number Information
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NPI Number | 1093447252
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Entity Type | Organization
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Legal Business Name | CLARITY DERMATOLOGY PLLC
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 2500 W PLEASANT RUN RD STE 215
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City | LANCASTER
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State | TX
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Zip | 75146-1170
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Country | US
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Telephone | 945-230-4312
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Fax | 972-478-0563
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Provider Business Mailing Address
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Address Line | 2432 WORTHINGTON ST
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City | DALLAS
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State | TX
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Zip | 75204-2503
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Country | US
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Telephone | 469-215-4699
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH WILDER
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Credential | MD
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Telephone | 469-215-4699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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